For Women Only

They may be juggling the multiple demands that have come to define modern life, but women in the Monterey Bay area tend to make time to be proactive about improving their health.

That was a pleasant surprise for Dr. Jill Tiongco when she began practicing here in 2009. Tiongco came from Arizona, where her work focused on older patients who tended to have specific health concerns, many that were age related.

But here she has found that women of all ages want to know what they can do to get or stay healthy.

“Preventive health is a wide topic that spreads across ages and diagnoses,” says Tiongco, an internist at Peninsula Primary Care, Community Hospital’s primary-care affiliate in Carmel. “We must do part of it on our own, and the other part, a physician plays a role.

“It starts with good nutrition, good exercise, and a good lifestyle. Yet health maintenance also requires talking with doctors, having annual exams, keeping current on vaccinations, and undergoing blood tests and other screenings for age-appropriate issues.”

Many maladies can be mitigated, delayed, or even prevented, Tiongco says, if we not only know what to do and when, but then actually do it.

Most of the screenings central to preventive care are recommended for both women and men: monitoring cholesterol, blood pressure, blood glucose, weight, and bone density, and having colon cancer screenings.

At the top of the “for women only” category are breast and pelvic exams.

The pelvic exam includes a Pap smear, the gynecological screening tool used to detect abnormalities in the cervix, pre-malignant lesions, and malignancies.

It is important to start having Pap smears by age 21, or no later than three years after sexual activity begins, as the incidence of cervical abnormalities goes up at that point, Tiongco says.

Among the conditions a Pap smear can detect is the human papilloma virus (HPV), which causes more than

70 percent of cervical cancers and at least 50 percent of precancerous lesions.

Dr. Jill Tiongco, internist at Peninsula Primary Care in Carmel.

“Our goal is to bring down the incidence of cervical cancer,” Tiongco says. “To this end, we now have two vaccines available that target the virus and prevent the development of precancerous lesions. We want to target females who are younger and have not been infected by HPV: young females at age 11 or 12, and some say as young as 9, before their sexual activity begins. Females between the ages of 13 and 26 who have not been vaccinated can have a ‘catch-up’ vaccination.”

When should women stop having Pap smears? The American Cancer Society says that women older than 70 who have had three or more normal Pap tests and no abnormal Pap tests in the last 10 years may choose to stop the screening. The guidelines of the U.S. Preventive Services Task Force call for discontinuing screening at age 65.

The other primary preventive measure for women is a breast exam. Women need to learn how to do a self-exam to detect changes in their breasts, Tiongco says. She cautions, however, that a selfexamdoes not replace a mammogram. Women should do both.

In 2009, the U.S. Preventive Services Task Force revised recommendations for mammograms, saying most women should begin the screenings at age 50 instead of 40. But the American Cancer Society and many doctors still recommend that women start the annual screening at the earlier age.

“Each patient is different,” Tiongco says. “Each needs to discuss her own risk factors with her physician todetermine her screening plan. Perhaps a bigger question is really when to stop screening. A good number of doctors recommend about 75 years of age, but it depends on whether or not we think the person has 10 or more years to live.

If so, we may recommend she continue screening for breast health.” Beyond having the basic screenings,many women of a certain age want to talk about two specific concerns: stress and menopause.

Many want a gauge of their stress and whether it is “normal,” Tiongco says. Usually, the answer is yes. Women are often juggling children, a spouse or partner, a job, and more; and some amount of stress comes with that expansive territory.

For women in their late 40s and into their 50s, menopause is often top of mind. They want to know whento expect it, what to expect, and what they can do about it.

“Because women experience menopause differently, I advise patients that they must have an individualized approach to care,” Tiongco says. “Previously at the onset of menopause, women were placed on hormones to prevent osteoporosis and heart disease. Today, we prescribe bisphosphonate drugs to address osteoporosis, and calcium and vitamin D to prevent it. We now prescribe hormones as a short-term therapy for symptomatic treatment of the discomforts that come up, such as hot flashes, night sweats, or the burning and dryness that can accompany vaginitis. It is important to discuss potential long-term effects of hormone replacement therapy.”

Discussing issues with a doctor is a common thread in Tiongco's advice.While her new female patients have been forthcoming about their interest in achieving or maintaining good health, she does find many of them reticent or remiss in other areas.

One is the use of supplements. Many patients don't think they need to include supplements when they list medications they are taking, but they should. Some supplements are beneficial, Tiongco says; but others may not be appropriate or necessary, and your doctor can help you evaluate which are which.

While the supplement discussion may be an oversight, other topics, like urinary incontinence, sometimes aren't raised out of embarrassment. Bring them up, Tiongco urges, because a full discussion of all health issues is part of being proactive.